Sunday, February 7, 2010


The American Diabetes Association has recently endorsed the new criteria of Hemoglobin A1c (Hgb A1c) of 6.5% or greater to make the diagnosis of Diabetes 1 or 2. This blood test which has been around for 20 years is now highly standardized, and commonly preformed in physician's office with a pin prick of blood. The Hgb A1c is a reflection of the last 3 months of sugars. If the sugar was 100 all the time it would be 4.5. The higher the sugars, the higher the number and the worse outlook for the patient. The older standard of a fasting blood sugar of greater than 126 or a 2 hour after eating level greater than 200 (or 2 hours after 75 gms glucose), in a patient with classic high blood sugar symptoms, a random blood sugar of the same 200 makes the diagnosis of diabetes.

Many known diabetics test their fasting blood sugars. This is in error in that this is usually the lowest blood sugar of the day, after all night fast and gives the patient a false sense that their diabetes is doing well. Let them do it 2 hours after a meal particularly a high carbohydrate one and it will give a more accurate status of the diabetes. The only time a fasting blood sugar helps is when one suspects a low level.

Most doctors would be happy if the A1c would be 7% or less. Not this doc. I want it under 6! Studies have shown, the closer the sugar is kept to 100, the less complications from the diabetes will occur. However, if very tight control is sought and the patient is taking sugar lowering medicines, the possibility of too low a sugar (hypoglycemia) could happen with dire and even lethal consequences. Levels above 8 % are associated with a significant all-cause mortality risk.

The doctor and you should know that anemia causes a false lowering of the A1c. Also older folks have a higher levels than younger people, and blacks have higher levels than whites for any given level of sugar. Nine percent of the population are “high glycators” or “low glycators” and give a falsly high or low reading in these cases This can be easily determined over the next several months with blood sugars or immediately with another similar test, a fructosamine.

The Metabolic Syndrome, a more malignant form of prediabetes or “increase risk for diabetes” is a level of Hgb A1c of 5.7. This corresponds to a fasting blood sugar between 100 and 125 or a 2 hour after eating height of greater than 140. This syndrome has in common with diabetes ear creases and the morbid complicators of diabetes. These are increased triglycerides, blood pressure, abdominal girth and a low HDL (healthy/good) cholesterol. In particular that individual has a 7 times higher incidence of having a cardiovascular event in the next 5 years than a person of the same age and sex without these gruesome characteristics!!

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